Posts in Category: value-based purchasing

Healthcare providers are prioritizing value-based payment models in 2018 IT budgets and data analytics is the category most likely to see an increase in spending, according to a survey from healthcare advisory firm Damo Consulting.

As the dust settles after the presidential election, it appears that Donald Trump is already softening some of his positions, especially his position on Obamacare. Media outlets have speculated that President Obama pushed hard for the continuance of his signature healthcare program when he met with Trump at the White House following the election.

Predictive Analytics
Q: How much of the healthcare industry has adopted predictive analytics?
A: By definition, negotiations between providers and payers are a game of who can better predict patient outcomes. Win-win scenarios can certainly be devised, but a lack of predictive ability puts an organization at risk for poor contract structuring.
Clinical outcomes are increasingly a game of predicting outcomes and identifying the levers that affect those outcomes so providers are able to improve on future outcomes. Operational predictions are also important, as misunderstanding patient care needs can lead to expensive outlier care patterns or care variations that break capacity management efforts and budgets.
Q: How do you see predictive analytics having an impact on healthcare organizations, and specifically on heart hospitals?
A: Outcome prediction and risk profiling will increasingly guide care pathway selection and tailor care patterns to targeted patient profiles. ... read more

Higher patient ratings equal fewer readmissions, lower mortality
The scores patients assign their hospitals appear to correspond with the quality of the hospitals' patient outcomes, according to a study published in JAMA Internal Medicine. Researchers analyzed the scores patients assigned to the Centers for Medicare & Medicaid Services' star-rating system for more than 3,000 hospitals. Hospitals' star ratings were inversely proportional to their rates of death within a month of discharge.
Hospitals reap $1.6M from specialists, including cardiologists
While the average primary care physician is generating less income for hospitals ($1.4 million in 2016 versus $1.56 million in 2013), that’s offset by specialist doctors, whose contribution to hospital revenues jumped 14% to $1.6 million, compared with $1.42 million three years ago. Among specialists, orthopedic physicians bring in the most business ($2.75 million each), followed by invasive cardiologists ($2.45 million) and ... read more

CMS targets hospital readmissions after CABG
A proposed rule from the Centers for Medicare & Medicaid Services (CMS) would penalize hospitals that perform an index coronary artery bypass graft (CABG) and then have an unexpected 30-day readmission, even if the patient was discharged from a different hospital. "The proposed CABG 30-day readmission measure includes Medicare beneficiaries who are 65 years old or older who at the time of the index admission had been enrolled in a Medicare fee-for-service program for at least 12 months," Cardiovascular Business reports. "CMS intends to add CABG to its readmissions reduction program in 2017."
Most support keeping, building on Obamacare
The Affordable Care Act (Obamacare) continues to have public support, with 36 percent of those surveyed saying it should be expanded, according to the latest Kaiser Health Tracking Poll. That's the position advocated by presidential candidate and former Secretary of State Hillary Clinton. Nearly... read more

CMS and health insurers announce alignment and simplification of quality measures
The Centers for Medicare & Medicaid Services (CMS) and America's Health Insurance Plans (the health plans' trade group) announced that they have agreed on seven sets of clinical quality measures. The standardized measures are designed to help payers and consumers shopping for high-quality care. "These measures support multi-payer alignment, for the first time, on core measures primarily for physician quality programs," according to the CMS. This work is informing the CMS’s implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Supreme Court: What will happen to healthcare cases after Justice Scalia's death?
A number of healthcare-related cases are in limbo following the death of conservative U.S. Supreme Court Justice Antonin Scalia, who died on Feb. 12. "The court is weighing a case about data sharing with potential implications for insurers and state... read more

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Companies Form New Alliance to Target Healthcare Costs
Hoping to hold down the cost of healthcare benefits, 20 large companies—including American Express, Macy’s and Verizon—have come together to use their collective data and market power. Members of the new alliance will share data about employee healthcare spending and outcomes, possibly using the data to change how they contract for care. "Some members say they could even form a purchasing cooperative to negotiate for lower prices, or try to change their relationships with insurance administrators and drug-benefit managers," Yahoo news reports.
Federal Insurance Marketplace Signs Up Millions of New Obamacare Users
The Obama administration reports that approximately 12.7 million new patients signed up for health insurance under the Affordable Care Act, or automatically... read more

Did you have a chance to check out the latest news from the cardiology and healthIT communities? Let us help keep you up to date on the stories you won't want to miss.
2016 may bring slower patient growth, higher wages, more expensive drugs
Late 2015 data support health systems' anticipation that the demand surge from patients newly insured under the Affordable Care Act would fade this year. Economists with the Altarum Institute say spending acceleration from the coverage expansion may have peaked last February.
FDA clears Biotronik's peripheral stent
The FDA has cleared Biotronik's Astron Peripheral Self-Expanding Nitinol Stent System, a device for improving luminal diameter in patients with iliac atherosclerotic lesions. The stent system is described as a self-expanding stent loaded on an over-the-wire delivery system.
Patients increasingly turning to mobile health apps
More than 30 percent of consumers last year said they have at least one health app on... read more

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